Choline on the Brain? A Guide to Choline in Chronic Fatigue Syndromehttp://phoenixrising.me/research-2/the-brain-in-chronic-fatigue-syndrome-mecfs/choline-on-the-brain-a-guide-to-choline-in-chronic-fatigue-syndrome-by-cort-johnson-aug-2005
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Irritable bowel syndrome and chronic fatigue six years after Giardia infection...

Abstract
BACKGROUND: Functional gastrointestinal disorders and fatigue may follow acute infections. This study aimed to estimate the persistence, prevalence and risk of irritable bowel syndrome and chronic fatigue six years after Giardia infection.

METHODS: Controlled prospective study of a cohort of 1252 individuals who had laboratory confirmed Giardia infection during a waterborne outbreak in 2004. In total, 748 cohort cases (exposed) and 878 matched controls responded to a postal questionnaire six years later (in 2010). Responses were compared to data from the same cohort three years before (in 2007).

RESULTS: The prevalences of irritable bowel syndrome (39.4%) by Rome III criteria and chronic fatigue (30.8%) in the exposed group six years after giardiasis were significantly elevated compared to controls with adjusted RRs of 3.4 (95% CI: 2.9 to 3.9) and 2.9 (95% CI: 2.3 to 3.4) respectively. In the exposed group the prevalence of irritable bowel syndrome decreased by 6.7% (RR: 0.85; 95% CI: 0.77 to 0.93), while the prevalence of chronic fatigue decreased by 15.3% from three to six years after Giardia infection (RR: 0.69; 95% CI: 0.62 to 0.77). Giardia exposure was a significant risk factor for persistence of both conditions and increasing age was a risk factor for persisting chronic fatigue.

CONCLUSIONS: Giardia infection in a non-endemic setting is associated with an increased risk for irritable bowel syndrome and chronic fatigue six years later. The prevalences of both conditions decrease over time indicating that this intestinal protozoan parasite may elicit very long term, but slowly self-limiting, complications.

I developed CFS about 8 years after I developed IBS - so I wonder how the results would have been different factoring in more time. And actually I had the stomach flu about 4 months before the onset of CFS... I've always felt like that was a catalyst for me.

Small intestine bacterial overgrowth plays for a large portion of IBS cases. Wonder how much of a problem that is for some here.

edit* Just read that the parasitic infection targets the small intestine, with cycles of life that includes cysts... Very interesting. Seems like these people still have an active infection that was not properly treated.

Fatigue was designed as a score of 4 or more on the Chalder fatigue questionnaire (bimodal scoring, 11-item version).

Unfortunately, they didn't try to assess CFS.

They also looked at severe fatigue which was a score of 23 or more on the Chalder fatigue questionnaire (likert scoring, 11-item version). One might guess that a reasonable percentage of these have CFS or a CFS-like condition.

Chronic giardiasis may give an IBS-like clinical picture. During the two years after the outbreak, patients with persisting symptoms in this cohort were thoroughly investigated in this respect at the hospital or by their general practitioners. All positive cases identified were successfully treated[14] and the carrier status in the exposed general population was very low.[28] Five years after the outbreak chronic giardiasis was assessed in this cohort by PCR of stool samples from 53 exposed persons with long-term CF and/or IBS and 20 exposed persons without sequelae and none were found to be positive.[29, 30] We therefore are convinced that the prevalence of chronic giardiasis in the exposed group is very low.

I thought it was interesting that those who has fatigue at 3 years in the post-giardia group were more likely to have fatigue at 6 years compared to the control group:

Prevalences of persisting IBS and CF were estimated among the individuals, who fulfilled the criteria for IBS or CF in 2007, and who also responded in 2010 (table S1). Out of 251 exposed individuals with CF in 2007, 146 (58.2%) still had CF in 2010, while the corresponding figures in controls were 16 (27.6%) out of 58. In a logistic regression model including gender, age and Giardia exposure we found that Giardia exposure was significantly associated with persisting CF with an RR of 2.13 (95%CI:1.55 to 2.64). Increasing age was associated with increased risk for CF with an RR of 1.43 (95%CI:1.14 to 1.69) in the 40-59 years age group, and an RR of 1.57 (95%CI:1.12 to 1.91) in the 60-97 years age group, compared to the younger 20-39 years age group. Among the 262 exposed individuals with IBS in 2007, 164 (63.1%) still reported IBS in 2010. Among the 64 controls with IBS in 2007, 25 (39.1%) reported IBS again in 2010. Giardia exposure was significantly associated with persisting IBS in 2010 with an RR of 1.64 (95% CI: 1.29 to 1.95) while age and gender were not.

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If one thinks of CFS research, there is some discussion on predictors of response/non-response or recovery/non-recovery. In a mixed fatigue group, this suggests that those whose followed an infection are less likely to recover than a mixed group (which presumably includes many whose fatigue wasn't due to an infection). This would be a different predictor to some of the psychological/biopsychosocial predictors that are mentioned sometimes.